Download Fat-Controlled Diet (25g or 50g)

Fat-Controlled Diet (25g or 50g)
PURPOSE -
A fat-controlled diet is used to relieve symptoms of diarrhea,
steatorrhea, flatulence, abdominal pain, and/or to control nutrient losses
caused by the ingestion of excess dietary fat.
USE -
This diet may be used in the treatment of diseases of the hepatobiliary
tract, pancreas, intestinal mucosa, and the lymphatic system as well as in
malabsorption syndromes in which digestion, absorption, or utilization
and transport of dietary fat is impaired. The latter include small bowel
resection, intestinal lymphangiectasia, abetailipoproteinemia, chronic
pancreatitis, Crohn’s disease, malabsorption in the elderly, and patients
with Acquired Immune Deficiency Syndrome (AIDS). The excretion of
more than 6g to 8g of fat (or over 10% of fat consumed) per day over a
3-day period following a fecal fat assay indicates overall fat
malabsorption. Further testing is needed to determine whether the
steatorrhea is caused by small intestinal, pancreatic, or hepatobiliary
disease. This diet is not designed for use in lowering serum lipid levels.
A low-fat diet may also be useful in the treatment of patients with
gastroe-sophageal reflux. A decreased fat intake will increase lower
esophageal sphincter pressure, thus reducing symptoms of heartburn and
dysphagia. Although steatorrhea is often a presenting symptom in celiac
sprue (gluten-sensitive enteropathy), adherence to a strict gluten-free
diet often brings about an end to steatorrhea, thus obviating the need for
a low-fat diet.
In individuals with cystic fibrosis, generally a low-fat diet is no longer
recom-mended since the advent of enteric-coated pancreatic enzymes.
Adequate doses of these supplements can normalize fat excretion in
these individuals. Liberalizing fat intake may increase the likelihood that
a nutritionally adequate diet will be consumed.
Many persons with malabsorption also may have difficulty tolerating
excess dietary fiber and/or lactose.
1
MODIFICATIONS -
In general, the 50-g-fat diet allows 6 oz of lean meat or meat substitutes
and three to five fat equivalents per day. A 25-g-fat diet allows 4 oz of
lean meat or meat substitutes per day and one fat equivalent per day
(Table 1). The food plan should be adjusted and individualized based on
food preferences and a person’s ability to monitor total fat intake.
Individual tolerance should be monitored closely and the level of fat
restriction adjusted if symptoms persist. Medium-chain triglycerides
may be substituted for some fat in the diet. Additional carbohydrates in
the form of starches and sugars also may be indicated for some patients
to meet caloric requirements. Protein intake can be increased with the
use of nonfat dairy products, as tolerated. Low-fat dietary supplements
also may prove useful to increase nutrient intake. Pancreatic enzyme
replacements may be prescribed by the physician. Mean fat excretion
may be significantly decreased when enzymes are given prior to meals.
RELATED
PHYSIOLOGY - Various alterations in the intestinal tract due to surgical, therapeutic,
genetic, or food sensitivities can contribute to fat malabsorption.
Interference with fat digestion or absorption can lead to diarrhea,
steatorrhea, and nutrient losses.
Disorders that affect gastric, pancreatic, and hepatobiliary function may
cause an impairment in the breakdown and digestion of fat. Lipase or bile
acid insufficiencies are the most common causes of maldigestion. The
deficiency of pancreatic lipase or the blockage of the pancreatic duct
results in reduced hydrolysis of dietary fat. This may occur in pancreatitis,
cystic fibrosis, and pancreatic cancer, as well as after a pancreatic
resection. Bile acid insufficiency results in reduced emulsification of fats
with a subsequent decrease in fat absorption. Hepatobiliary disease, ileal
disease or resection, and bacterial overgrowth in the intestines can all
result in diminished bile acid activity.
Malabsorption of fat occurs when the structure or function of the small
bowel mucosa is altered or damaged (as in Crohn’s disease or deliac
sprue) and when there is a decrease in the mucosal surface areas (as in
short bowel syndrome). Patients with steatorrhea from ileal disease often
need to restrict fat and oxalate in their diet and often require monthly
injections of vitamin B-12. A fat restriction may also be indicated for
patients with defects in the lymphatic transport of fat (as in intestinal
lymphangiectasia) and for the management of disorders in which fat
utilization is impaired (as in abetailipoproteinemia).
2
TABLE 1
GUIDELINES FOR FOOD SELECTION FOR FAT-RESTRICTED DIET
(25 G or 50 g of fat)
Food Groups
Foods Recommended
Foods to Avoid
Beverages
To be taken as desired
(fat/serving: trace)
Cocoa made with cocoa powder and
skim milk; coffee; tea; soft drinks; fatfree powdered drinks; juices
Whole-milk beverages; added cream or
chocolate
Breads and cereals
6-11 servings/d
(fat/serving:< 1g)
Whole-grain breads, enriched
breads; saltines, soda crackers,
other low-fat crackers; cooked
cereals, whole grain cereal except
granola type; plain corn or flour
tortillas; bagels
Desserts
In moderation
(fat/serving: trace)
Skim-milk sherbet, fruit ice, gelatin;
angel food cake; vanilla wafers;
graham crackers; meringues; skimmilk pudding; fat-free commercial
baked products; nonfat ice cream
and frozen yogurt; fruit whips with
gelatin
Fats
Amounts listed equals 1
at
equivalent; 3-5 equivalents/d
allowed for 50g fat;
1 equivalent/d allowed
for 25 g fat. Unsaturated
fats are recommended
(fat/serving: 5 g)
Unsaturated Fats
Biscuits; breads containing egg or cheese; sweet
rolls; pancakes; French toast; doughnuts;
waffles; fritters; muffins; granola-type cereals
and breads to which extra fat is added;
popovers; snack crackers with added fat; snack
chips; stuffing; fried tortillas
All other cakes, cookies, pies, and pastries;
pudding made with whole milk or eggs; cream
puffs and eclairs; ice cream
Any in excess of recommended amounts.
Margartine (1 tsp)
Diet margarine (1tbsp)
Fat-free margerine*
Mayonnaise:
reduced -calorie (1 tbsp)
regular (1 tsp)
fat-free*
Creamy salad dressings:
reduced -calorie (1 tbsp)
regular (2 tsp)
fat-free*
Vegetable oils (1 tsp)
Nuts:
cashews(1 tbsp) or 2
whole almonds (6 whole)
peanuts (20 smaller or 10 large)
peanut butter (2 tsp)
cashew butter (2 tsp)
walnuts (2 whole)
pistachios (18 whole)
other nuts (1 tbsp)
Seeds:
sesame (1 tbsp)
sunflower (1 tbsp)
pumpkin (2 tsp)
Olives (10)
* Some "fat-free" items contain trace amounts of fat and should not be eaten indiscriiminately. Check food lables and/or consult food manufacturer for
individual items.
3
TABLE 1
Food Groups
Fruits
GUIDELINES FOR FOOD SELECTION FOR FAT-RESTRICTED DIET
(25 G or 50 g of fat)
Foods Recommended
Saturated Fats
Bacon (1 slice)
Bacon fat (1 tsp)
Butter (1 tsp)
Whipped butter (2 tsp)
Chitterlings (1/2 oz)
Shredded coconut (1 tbsp)
Cream:
light, coffee, table (2 tbsp)
heavy whipping (1 tbsp)
Sour cream (2 tbsp)
Cream cheese:
light (2 tbsp)
regular (1 tbsp)
Coffee whitener:
liquid ( 2 tbsp)
powder ( 1 tbsp)
Lard ( 1 tsp)
Shortening (1 tsp)
Salt Pork (1/4 oz)
Oils:
coconut (1 tsp)
palm (1 tsp)
Fresh, frozen , canned, or dried fruit;
fruit juices
Foods to Avoid
Avocado in excess of amount allowed on fat
list
2-4 servings/d
(fat/serving: trace)
Lean meat and meat
substitutes
For 50-g-fat diet, 6 oz/d
For 25-g-fat diet, 4 oz/d
(fat serving: 3 g)
Recommended preparation
methods are broiling;
roasting, grilling or boiling;
weigh meat after cooking.
Note: All visible fat and
poultry skin should be
trimmed prior to eating.
Amount stated denotes
cooked portion
Fish
All fresh, frozen, or canned in water:
crab lobster, scallops, shrimp, clams,
oysters, tuna: herring (uncreamed or
smoked); sardines ( canned, drained);
salmon (canned in water)
Tuna (packed in oil), salmon (packed in oil)
(continued)
4
TABLE 1
GUIDELINES FOR FOOD SELECTION FOR FAT-RESTRICTED DIET
(25 G or 50 g of fat)
Food Groups
Foods Recommended
Foods to Avoid
Poultry
Chicken, turkey, Cornish hen
Duck, goose
Veal
All cuts are lean except those listed
under foods to avoid
Cutlets (ground or cubed)
Lean beef
USDA select or choice grades such
as round, sirloin, and flank steak;
tenderloin; chopped beef
Lean pork
Fresh, canned, cured, or boiled ham;
Canadian bacon; tenderloin
Most USDA prime cuts, such as ribs, corned
beef, ground beef, roasts (rib, chuck, rump);
most steak including cubed, T-bone and
Porterhouse; meatloaf
Spareribs; ground pork; pork sausage (parry or
link); chops; loin roast; Boston butt; cutlets;
ham hocks; pigs' feet; chitterlings
Lean lamb
Arm, foreshank, leg, loin, and shank
cuts
Patties (ground lamb), blade, rib, and shoulder
cuts
Luncheon meats
95% fat-free; lean ham, turkey or beef
Luncheon meats such as bologna, salami,
pimento loaf
Legumes
Cooked or canned without added fat
Legumes cooked with added fat
Soy Products
Natto (3 1/2 oz = 11g fat);
All other cakes, cookies, pies, and pastries;
pudding made with whole milk or eggs; cream
puffs and eclairs; ice cream
tempeh (3 1/2 oz = 8 g fat);
tofu (3 1/2 oz = 9 g fat);
Cheese
Any cottage cheese; low-fat cheeses
made with skim milk and containing 3
g of fat or less per oz; parmesan
cheese, grated (2 tbsp = 1 oz), ricotta
cheese, part skim
All regular cheeses including:
American , blue, brie, cheddar, colby, monterey
jack, and Swiss
Milk
2 or more servings/d
(fat/serving: trace)
Skim milk, skim buttermilk, powdered
and evaporated skim milk; nonfat
yogurt
1%, 2%, whole milks, buttermilk made with
whole milk; chocolate milk; cream; regular
evaporated milk; whole milk yogurt
Eggs
In moderation
(fat/serving: trace)
Egg whites and fat-free egg substitutes
Egg yolks
Potatoes and potato
substitutes
As desired
(fat/serving: trace)
Potatoes; rice; barley; noodles
without yolks; spaghetti, macaroni;
and other pastas
Fried potatoes; fried rice; potato chips; chow
mein noodles; items prepared with added fat,
such as au gratin potatoes, unless fat is
deducted from fat allowance
Soups
As desired
Fat-free broth; fat-free vegetable
soup; cream soup made with skim
milk and allowed fat; packaged
dehydrated soups
All others
(fat/serving: trace)
(continued)
5
TABLE 1
GUIDELINES FOR FOOD SELECTION FOR FAT-RESTRICTED DIET
(25 G or 50 g of fat)
Food Groups
Foods Recommended
Foods to Avoid
Sweets
In moderation
(fat/serving: trace)
Sugar; honey; jelly; jam;
marmalade; molasses; maple
syrup; sour balls; gum drops; jelly
beans; marshmallows; hard candy;
cocoa powder
Candies made with bitter, coconut,
chocolate, or cream
Vegetables
3-5 servings/d
(fat/serving: trace)
All fresh, frozen, or canned
vegetables prepared without fats
or sauces containing fat
Buttered, au gratin, creamed, or fried
vegetables unless made with allowed fat
Miscellaneous
In moderation
(fat/serving: trace)
Ketchup; chili sauce; vinegar;
pickles; vanilla; unbuttered
popcorn; white sauce made with
skim milk and allowed fat:
mustard; all herbs and seasonings;
apple butter
Olives and nuts in excess of specified
portion; cream sauces; gravies; buttered
popcorn
ADEQUACY -
The diet is adequate in all nutrients based on the 1989 recommended
Dietary Allowances. Prolonged diarrhea or steatorrhea may lead to
nutrient deficiencies including calcium, iron, magnesium, potassium,
zinc, fat soluble vitamins (A, D, E, and K), folic acid, and vitamin B12. While other water-soluble vitamin deficiency states are rarely
associated with malabsorption, the vitamin B complex is also
sometimes supplemented.
Vitamin and mineral deficiencies can be treated with supplements
and control of causative factors. Medium-chain triglycerides can be
incorporated to provide additional calories.
Table 2 contains a sample menu for diet allowing 25 g of fat.
6
TABLE 2
SAMPLE MENU FOR FAT-RESTRICTED DIET (25g of fat)
BREAKFAST
Orange juice (1 cup)
Whole-grain cereal (3/4 cup)
Banana ( 1 medium)
Whole-wheat toast (1 slice)
Diet margarine (1/2 tsp)
Jelly or jam (2 tbsp)
Skim milk (1 cup)
Coffee/tea
LUNCH
Fat-free vegetable soup ( 1 cup)
Saltine crackers (4)
Sliced turkey breast (2 oz)
Whole-wheat bread (2 slices)
Mustard (1/2 tbsp)
Fat-free mayonnaise (1 tbsp)
Slilced tomatoe (1/2 medium)
Lettuce
Fresh fruit salad (1/2 cup)
Graham crackers (4)
Skim milk (1 cup)
Coffee/tea
DINNER
Tossed green salad (3 1/2 oz)
Fat-free salad dressing (1 tbsp)
Broiled boneless skinless chicken
breast (3 oz)
Herbed brown rice (1/2 cup)
Steamed broccoli (1/2 cup)
Whole-grain roll (1)
Diet margarine (1/2 tsp)
Jelly or Jam (1 tbsp)
Fruit ice (1/2 cup)
Meduim apple (1)
Coffee/tea
SNACK
Canned peaches (1 cup)
Nonfat plain yogurt (1/2 cup)
APPROXIMATE NUTRIENT ANALYSIS
Energy (keal)
Protein (g)
(18.4% of keal)
Carbohydrate (g)
(76.2% of keal)
Total fat (g)
(10.0% of keal)
Saturated fatty acids (g)
Monounsaturated fatty acids (g)
Polyunsaturated fatty acids (g)
Cholesterol (mg)
Calcium (mg)
Iron (mg)
Magnesium (mg)
2,173.7
100.2
414.2
24.1
6.6
8.0
5.8
111.1
1,237.5
16.2
560.1
Phosphorus (mg)
Potassium (mg)
Sodium (mg)
Zinc (mg)
Vitamin A (µg RE)
Vitamin C (mg)
Thiamin (mg)
Riboflavin (mg)
Niacin (mg)
Folate (µg)
Vitamin B-6 (mg)
Vitamin B-12 (µg)
Dietary fiber (g)
Water-insoluble fiber (g)
1,888.4
5,256.9
3,100.4
13.9
2,863.7
223.5
2.3
2.8
33.2
670.1
3.7
6.0
43.7
31.2
7